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The global community already possesses the tools necessary to ultimately end the AIDS epidemic. This is the readily apparent take-home conclusion of the July 23 opening plenary session of the XIX International AIDS Conference (AIDS 2012), featuring Anthony S. Fauci, MD, director of the National Institute of the Allergy and Infections Diseases (NIAID) at the National Institutes of Health; Phill Wilson, president and CEO of the Black AIDS Institute; and U.S. Secretary of State Hillary Rodham Clinton.

From Science to Implementation

“We are on scientifically solid ground when we say we can end the HIV/AIDS pandemic,” Fauci explained. “We have the scientific tools to consider an AIDS-free generation.”

An AIDS-free generation entails that first, no one will be born with the virus; second, that as people get older, they will be at a far lower risk of becoming infected than they are today; and third, that if they do acquire HIV, they will get treatment that keeps them healthy and prevents them from transmitting the virus to others.

Citing the scientific breakthroughs accomplished in the last 30 years—notably the development of highly effective antiretroviral therapy and evidence-based prevention—as well as the mobilization of community organizations, nonprofits and the global community, Fauci told delegates attending the session on the first full day of the conference in Washington, DC, that there exists, for the first time, a true opportunity to make a dent in the HIV epidemic and eventually end it. But there is still work to be done.

More than 34 million people worldwide are living with HIV, including more than 1 million individuals in the United States. And despite international programs and global partnerships, nearly half of all people infected with HIV living in low- and middle-income countries are not receiving the life-sustaining medication they need. And in fact, only a small group of people living with HIV worldwide have actually been tested for the virus and linked to clinical care.

What’s needed? According to Dr. Fauci, the global community should focus on retaining patients in treatment, using treatment as prevention and promoting voluntary medical male circumcision (which is known to reduce a heterosexual man’s risk of acquiring HIV by up to 60 percent). Finally, and importantly, Fauci noted the need for a global commitment from communities and governments to build and strengthen health care systems capable of providing HIV treatment and prevention services.

“Ending the HIV/AIDS pandemic is an enormous and multifaceted challenge but we now know it can be done,” Fauci said.

The Deciding Moment

Echoing Fauci’s call for prioritization, Phill Wilson of the Black AIDS Institute outlined five steps to end AIDS.

First, Wilson called for full implementation of the Patient Protection and Affordable Care Act, which could insure more than 30 million currently living without access to healthcare.

Next, he asked that everyone living with HIV come out, helping to minimize stigma and build a demand for essential health services.

Third, Wilson called for treatment on demand, stressing to delegates that they won’t get what they don’t ask for. Wilson emphasized building a grassroots demand for treatment.

Wilson also underscored the necessity of combining biomedical and behavioral therapies. “The crucial point here is that it's not an ‘either/or’ but rather both/and’,” he said.

Finally, Wilson called for AIDS organizations to retool themselves and adapt to the new landscape. Saying that most community organizations focus only on behavioral interventions, Wilson called for organizations to expand to include valid scientific expertise and deliver medical care and services.

Though there is still considerable work to be done, Wilson noted, he remains optimistic.

“It is in the caring and the fighting and the loving that we live together,” Wilson said. “This is our time. This is our deciding moment. Together we are greater than AIDS.”

An AIDS-Free Generation

“Yes, AIDS is still incurable, but is no longer has to be a death sentence,” said Secretary of State Hillary Rodham Clinton.

After welcoming the AIDS conference back to the United States for the first time in 22 years, Clinton focused her speech on building an AIDS-free generation, what progress has been made, and what is yet left to accomplish.

Referencing the gains of the Obama administration over the past year, Clinton explained that the President’s Emergency Plan for AIDS Relief (PEPFAR) has provided funding for the treatment of nearly 600,000 more people living with HIV, reaching nearly 4.5 million people and staying on track to the meet the President’s goal of treating 6 million people by the end of 2013. PEPFAR also supported more than 400,000 male circumcision procedures. Finally, it reached more than 370,000 women globally, putting PEPFAR on track to secure HIV treatment for 1.5 million women by the end of 2013.

Still, there are barriers to overcome.

Clinton said that the global community must address the needs of all people living with HIV, including high-risk groups that are often ignored like women, orphans and children, and injection drug users. Countries must also have difficult conversations about government services and accountability and, ultimately, provide necessary resources.

In turn, Clinton called on U.S. Global AIDS Coordinator Eric Goosby to draft a blueprint to help the U.S. government achieve these goals.

In addition to calling for a blueprint, Clinton announced a number of other committments: First, an additional $80 million for programs focusing on pregnant women living with HIV; second, an addition $40 million to support South Africa’s plans to provide voluntary medical male circumcision for half a million boys and men; third, $15 million for research focused on identifying successful prevention interventions for high risk groups; fourth, $20 million to support country-led plans to expand services for their key populations; and finally, a $2 million investment in the Robert Carr Civil Society Networks Fund to support civil society groups.

In conclusion, Clinton asked delegates to keep the faith.

“We are all here today because we want to bring about that moment when we stop adding names [to the AIDS Memorial Quilt], when we can come to a gathering like this one and not talk about the fight against AIDS, but instead commemorate the birth of a generation is free of AIDS,” Clinton said. “We are closer to that destination than we’ve ever been and as we continue on this journey together, we should be encouraged and inspired by how far we’ve already come.”

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